Events

Cherona

Good evening, everyone, and thank you for joining us. We'll give it just another moment or two to allow everyone to get settled.

Once again, good evening and a very warm welcome, to our webinar on Glaucoma treatment. My name is Cherona, and I'm hosting tonight's session. I'm delighted to be joined by our expert speaker, Mr Tassos Lavaris, consultant ophthalmic Surgeon.

Tonight's session will begin with a presentation from Mr Lavaris, followed by a live Q&A.

If you have questions at any point, please feel free to submit them using the Q&A icon at the bottom of your screen.

You're welcome to ask anonymously or include your name.

Just a quick note, though, that the session is being recorded, so any names shared may be visible in the recording. To help us get through as many questions as possible, please do keep them brief. If you're interested in booking a consultation, we'll share all of the relevant contact details

At the end of the session.

I will now hand over to Mr Lavaris.

Mr Anastasios Lavaris

Thank you, Cherona.

Good evening, everyone, and thank you for joining us. I am Mr Anastasios Lavaris, I'm a consultant ophthalmic surgeon, and today we'll talk about glaucoma and the treatments available.

Particularly laser and surgery.

My aim is to explain the options in clear language so that you feel better informed when discussing your own care with your eye specialist. This is general information, of course, and the right treatment for you is always depends on the individual and the stage of the disease.

A little bit about my background. I lead the Glaucoma service at East Kent Hospitals, and I specialize in Glaucoma management and cataract surgery. I completed my fellowship training at Morefields Eye Hospital in London, and the University Hospital of Wales in Cardiff.

My work includes minimally invasive glaucoma surgery, drainage implants, and more complex operation, as well as cataract surgery, of course.

My research background includes a PhD exploring the genetics of primary open angular Glaucoma, and published peer-reviewed papers.

So, what we will cover today, we will start with what Glaucoma is and why it matters, then look at symptoms, diagnosis, and what happens when you're referred for an assessment.

We will go through eye drops, laser treatments, and surgical options, and of course, we will finish with time for your questions. So, please use the Q&A function during the session, and we will try to address as many questions as we can at the end.

Starting with, what is Glaucoma?

Glaucoma is a group of eye conditions that damage the optic nerve. The optic nerve is the cable that carries visual information from the eye to the brain.

It is more common as we get older, and if left untreated, it can lead to permanent, sight loss.

Often, but not always, the damage is associated with increased pressure inside the eye. We call that intraocular pressure.

The important message is that early detection and appropriate management can greatly reduce the risk of further vision loss.

The most common type in the UK, the most common type of glaucoma in the UK, is the primary open angle glaucoma.

The ice drainage device, the ice drainage angle, as we call it, remains open, but fluid does not leave, efficiently enough.

In angle closure glaucoma, the drainage angle becomes narrow or blocked.

Some people may develop optic nerve damage despite the pressure being in the statistically normal range. We call this variant of glaucoma normal tension Glaucoma.

It can also develop after inflammation, trauma, steroid treatment, or surgery.

Identifying the type of your Glaucoma matters, because the best treatment may differ.

Moving on to risk factors. Age and family history are very important risk factors.

If you have a first-degree relative, a parent, or sibling with glaucoma, your own risk is higher, so routine eye examinations become particularly valuable.

Some ethnic backgrounds carry increased risk of glaucoma, certain types of glaucoma, and of course, eye characteristics such as short-sightedness or long-sightedness may be also relevant.

Diabetes and other medical factors may be considered during your assessment?

High pressure is the main and only modifiable risk factor of glaucoma.

But Glaucoma is not simply a disease of high pressure.

So, how eye pressure builds up inside the eye?

The eye constantly produces a clear fluid called aqueous humor.

It passes through the pupil and normally drains through structures near the junction of the cornea and the iris, including the trabecular meshwork.

If the fluid cannot leave the eye efficiently.

Pressure may rise inside the eye.

Over time, optic nerve fibres can be damaged from raised pressure, so our treatments either reduce fluid production inside the eye, improve its drainage, or create another passage, usually with surgery, for the fluid to leave the eye.

Most common, symptoms of glaucoma? Usually none. Glaucoma is often silent.

Especially open angular Glaucoma may have no noticeable symptoms in the early stages.

Changes tend to develop slowly and gradually over time, often affecting peripheral vision first, so they can be difficult to recognize.

Both eyes are usually affected, although one eye might be more advanced.

This is why regular eye checks matter, even if you can read, drive, and see comfortably. So, waiting for symptoms is definitely not a reliable way to detect glaucoma.

All symptoms of this slide, such as severe eye pain, redness, halos around lights, blood vision, headache, or even nausea.

can occur with an acute rise in eye pressure, a condition that we often call acute angular closure. This is different from the usual silent cause of open angular glaucoma.

So, if someone develops a painful red eye with sudden blurred vision, particularly with nausea or headache, they should definitely seek urgent same-day eye assessment, rather than wait for your routine appointment.

Glaucoma is usually detected through a combination of tests.

Rather than just an eye pressure measurement.

Your optometrist may check your eye pressure, examine your optic nerve, or even assess your field of vision.

In a specialist clinic, we use OCT imaging to look more in depth at the nerve fibre layer, or we also examine the drainage angle of the eye.

We generally recommend, routine eye examinations at least every two years.

Especially past the age of , with more frequent checks where appropriate for people who are at increased risk.

Your own optometrist can advise on the interval that is right for you.

For many patients, your journey begins at a routine optician appointment. If the findings suggest that there might be glaucoma in your eyes, your optometrist will refer you for a specialist assessment.

Sometimes cataract and glaucoma may coexist, so we may consider how best to manage both conditions together.

At Benenden Hospital, appointments may be arranged through self-paid or private medical insurance, depending on your individual circumstances, but our aim is always to establish a clear diagnosis and agree on a plan that will protect your site.

During your visit, our experienced team will take a history and perform the tests needed to assess your eye health.

These tests may include eye pressure measurement, optic nerve imaging.

visual field testing, and an examination of the eye. We will explain what the results mean, and we will discuss whether observation, drops, laser, or surgery is more suitable for you. If an operation is planned, there may be a pre-assessment appointment and a separate discussion of benefits, risks, and recovery.

It is also very important to bring your own medication list and any questions that you may have, of course.

So, here at Benenden Hospital, you will find a dedicated eye unit with a very experienced team supporting you throughout your assessment and treatment.

Our facilities, equipment, and our coordinated nursing and administrative support teams all contribute to a smoother experience for you.

After all, a Glaucoma pathway is not just about an operation. Careful testing, follow-up, and clear communications, clear communication is essential.

Moving on to glaucoma treatment,

Why we treat Glaucoma? Of course, at present, we cannot reverse optic nerve damage that has already happened.

So, the aim of our treatment is to reduce the likelihood of further damage to your eye and preserve useful sight for the future.

Lowering eye pressure is the only evidence-based, proven treatment strategy.

So, the target pressure that we may set varies from patient to person according to the amount of existing, the rate of change over time, and other risk factors.

Some patients with early glaucoma, for example, can be just monitored.

Others might benefit from drops, laser, or even surgery.

Moving on to treatment options, eyedrops.

We very commonly prescribe eye drops as a first-line treatment. They lower pressure by reducing fluid production or improving drainage system of the eye. Laser treatment, and especially selective laser trabeculoplasty, helps the eye's existing drainage system to work more effectively.

And surgery may create a new, drainage route.

As with trabeculectomy tube implant, or improve the eye's own outflow system.

As with a certain minimally invasive surgical procedures, like the eye stent.

We choose between these options according to Glaucoma severity.

Pressure target levels, other eye conditions, and of course, your preference.

Not every operation works in the same way.

There are several families of Glaucoma drops.

They work either by reducing fluid production or improving outflow through different mechanisms. Often we start with one medication and adjust according to pressure response and tolerability. It is very important to use these drops consistently, every day.

And to tell us about side effects, of course, or get difficulty putting them. Different drops.

Have different options different cautions, so, your medical history and other medicines that you may be taking matter.

Moving on to laser treatment. Laser treatment can be an alternative to, or addition to, eye drops for suitable patients, with open angular Glaucoma or ocular hypertension.

SLT, or selective laser trabeculoplasty, targets a trabecular meshwork, and it stimulates a biological response that can improve drainage. It does not involve cutting or destroying any structures inside the eye.

Therefore, the procedure is performed in our clinic, not in theatre, with anaesthetic drops, and it is relatively quick. It can reduce pressure substantially, although the amount and duration of benefit may vary between patients.

If you choose to have this treatment.

Before your treatment, we put eye drops to numb your eye, and we might, give you additional eye drops to prepare your eye and reduce the chance of a pressure rise during or shortly after your laser.

A special contact lens is used, it is placed on the surface of the eye while the laser is applied. You might notice flashes or hear clicks, and you might feel mild discomfort.

Afterwards, our team will check your pressure and explain whether any temporary medication or follow-up is required.

Of course, you can go home on the same day, but please do follow our team's advice on driving and aftercare.

SLT is nowadays a first-line treatment.

And the key message of this slide is that it works well for most people, but it is not a permanent cure.

There's high initial success rate, and SLT offers a good longer-term control.

In a substantial proportion of patients.

Initial success rate is around 80%.

And after six years, seven in ten people will still have good eye pressure without requiring other treatments. So, some patients might still need drops later, or we can repeat SLT. Repeat SLT can be considered when the effect of the laser wears off.

Of course, we monitor your optic nerve and your eye pressure over time, regardless of the initial response.

After your laser treatment, your vision might be slightly blurred in your eye. Your eye might feel a little bit gritty, red, or light sensitive for a short time. Occasionally, the eye pressure might rise temporarily, which is why post-laser pressure check and instructions are very important.

Serious complications are thankfully extremely rare.

But please do contact our team if you, develop significant pain or worsening vision.

Moving on to minimally invasive surgery, the eye stand is now available here at Benenden Hospital.

The eye stand is a very small implant place within the eye's natural drainage pathway.

To help fluid bypass resistance at the trabecular meshwork.

It is an example of minimally invasive glaucoma surgery, and it is often combined with cataract surgery in suitable patients with glaucoma and cataracts.

It adds only five minutes to the cataract procedure.

And it has an excellent safety profile.

Compared with traditional filtering glaucoma surgery, these procedures generally involve less tissue disruption, but they typically achieve a more modest pressure reduction and are suitable for mild to moderate glaucoma.

So, the best choice depends on how advanced your Glaucoma is, and what the target pressure that we need to reach is.

Let's watch now a short, video about the iStent.

So you saw how the, how the stent looks inside the eye.

The iStent is the smallest implantable medical device in the world. It is a medical-grade titanium device. It is compatible with all MRI and CT scanners.

The body doesn't reject it, and allergic reactions to that are exceptionally, exceptionally rare.

So, we've covered the main treatment options available here at Pennington. It is probably a good time to invite any questions, so you can use the Q&A icon to ask your questions, but please note that the session is being recorded if you choose to provide your name.

I would like to thank you once again for joining us. The main message I would like you to remember is that Glaucoma is often symptom-free, but timely diagnosis and proper treatment can protect vision. We now have a range of options, from monitoring and drops to lasers and surgery.

And we can tailor them to the needs of each patient. So, if you would like to explore an assessment on Benenden Hospital, all contact details are on the screen. Over to you Cherona.

Cherona

Lovely, thank you. So thank you, and we are going to move into the Q&A session. We're really pleased to have so many of you with us today. So, Mr Lavaris, if I can just move through some of the questions that we have available.

Mr Jordan has said that he has damage to his optic nerves, said to be caused by glaucoma, although his pressure has never exceeded 22. He's asking if this is common. He said his cup-to-disc ratio is 0.9 nine.

Pressure reduction and stents and laser surgery have been suggested. We're just trying to see whether you think that this is appropriate.

So, thank you for your question. Zach, if this is a case of what we call normal tension glaucoma, then all treatment options are reasonable for you.

If your Glaucoma tends to is already advanced, or if your glaucoma has progressed, quickly over time.

Probably the best option for you would be eye drops or even surgery. We usually we usually rely on a surgical procedure called trabeculectomy that works particularly well, for normal tension glaucoma. Lasers and stents can be an option.

But this is not the most common way that we treat normal tension Glaucoma.

Cherona

Thank you.

And thank you to, Mr Jordan, we hope that that answers your question. Another question that we have is, how is normal pressure glaucoma diagnosed?

Mr Anastasios Lavaris

So, normal pressure glaucoma is I would say the most commonly misdiagnosed condition.

You need an assessment to confirm that you have true normal tension glaucoma.

If you have been diagnosed with Glaucoma and your pressure is still within the normal range, we usually start with a good history.

You've probably used steroid medications in the past, or you might have a condition called pigment dispersion, so your pressure might have been raised in the past.

It might have caused damage, but your Glaucoma might have might be stable at this point, so it might not even need any treatment.

The other assessment that is essential when we are diagnosing normal tension Glaucoma is the state of your ankle.

Because I see patients frequently that have been diagnosed with normal tension glaucoma while they actually have angle-closure Glaucoma. This is why it is important to have a specialist assessment to look at the drainage angle of your eyes, because treatment is different.

So, if we reach to the conclusion that you have normal pressure Glaucoma, still your the treatment is the same. Reduction of pressure, despite your pressure being within the normal range. It needs further reduction.

A big trial, done a couple of decades ago, but it is still, it is still relevant, so that approximately % of people diagnosed with glaucoma will not experience any change, will not experience any deterioration over time. So if your glaucoma is not already advanced.

It might be reasonable to just monitor it without offering treatment. But if there's already, existing advanced damage, then probably treatment is required.

Cherona

Thank you. One of our attendees has been diagnosed with white coat syndrome. Could this affect his eye pressure readings?

Mr Anastasios Lavaris

I wouldn't say that white coat syndrome is

is something that, there's no there's no evidence about white coat syndrome, directly affecting your eye pressure, and, this is

This is not the way that we diagnose and we monitor glaucoma. This is why we do not just rely on a pressure reading.

The most important, and the way that we diagnose and monitor glaucoma is the assessment of your optic nerve via a direct examination, or what we call an OCT scan and your visual field.

So, even if your pressure is raised, because, let's say you wear a tight collar at the time of your examination, or because it is part of the normal fluctuation during the day, because the eye pressure fluctuates during the day in people with glaucoma, and also in people without glaucoma.

This is why it is important to have a proper assessment of your optic nerve and your field of vision, rather than just set a diagnosis based only on eye pressure.

Cherona

Thank you. Thank you.

So, another question that we have is, can you have an eye stent put in after cataract surgery? So I know during your, presentation, you mentioned that it is often, a procedure that is done in combination with one another. However, this question, seems to pertain to whether you could have the eye stent as a standalone procedure after cataract surgery?

Mr Anastasios Lavaris

We do offer that in selected cases, but, probably the best the best option for you, if you've already had cataract surgery would be to, to use eye drops, to have laser treatment, such as the SLT, or if those don't work, then you might need surgery with trabeculectomy, a bigger shunt, rather than just a standalone eye stand. A standalone eye stand, in most cases, does not offer

A meaningful pressure reduction.

It works particularly well during cataract surgery.

Cherona

Right, okay.

That's great, thank you. So, Mr Saunders has a reading that is 20.6, and, I think in his right eye, and 16.7 He was told that he would.

Oh, sorry contacted, that's fine.

We have another attendee who said he had SLT treatment about  months ago?

The consultant confirmed that he didn't think it had worked. Can these treatments be repeated?

Mr Anastasios Lavaris

We usually tend to repeat the SLT laser if it has demonstrated an initial effect.

Usually, as the effect of laser, of SLT laser, lasts anywhere between one and  five years. It might start wearing off over time. So, if we know that SLT worked the first time, we might, repeat it. And actually, the second treatment might produce, a bigger and longer-lasting pressure lowering effect.

But if your first treatment hasn't worked, probably the second one will not work either, so I would suggest exploring other options.

Cherona

Lovely, thank you. We have a lady who's attended, and she's mentioned that her husband has had laser surgery for ocular hypertension, and is currently taking eye drops. Her question is, would surgery stop her husband from having to take eye drops night and day?

Mr Anastasios Lavaris

Theoretically, it would. It does in most cases, but not always. So if your husband, if your husband, if your husband's ocular hypertension has been stable with this combination of drops, probably, my suggestion would be to just carry on with those drops, or since he has had laser, and he has not been diagnosed with Glaucoma. He has only just been diagnosed with ocular hypertension, that essentially means raised pressure without any damage in the eye, in the optic nerve.

Properly removing dorzolamide under close monitoring for a trial period might be reasonable.

So, his doctor might recommend removing dorzolamide, stop using dorzolamide, carry on using bimatoprost, because bimatoprost is the main IOP-lowering agent here. And then, let's say, have a pressure assessment a few weeks after that to see if he can just carry on being monitored only on one medication rather than two.

Cherona

Thank you. For those of us who wear prescription, glasses, would your prescription need to change once you've had laser treatment?

Mr Anastasios Lavaris

Laser does not affect prescription, so your prescription will remain the same.

Cataract surgery with or without an eye stand, of course, would result in an update prescription. Most people do not need glasses for distance vision following the cataract surgery, but a pair of readers is usually required.

Cherona

Thank you.

We have a question here that says, I have low pressure glaucoma. This person has had two sessions of laser treatment and uses, drops daily, very compliant, and has an, epiretinal membrane in their right eye. What would you recommend?

Mr Anastasios Lavaris

If your Glaucoma if your Glaucoma remains stable and you can't tolerate your drops, then probably I don't see any reason changing your regime. The upper retinal membrane is a macular problem, which is not treated by, by eye drops or laser or any surgery that we offer.

So, this is probably, this also requires an independent assessment with a retinal surgeon.

Rather than a Glaucoma surgeon.

since you've had two sessions of laser treatment, probably I wouldn't recommend another laser, just monitoring for now, if you can tolerate your eye drops. If your Glaucoma progresses, as I said, normal tension or low pressure glaucoma might require filtering surgery, such as trabeculectomy.

We don't we don't offer eye stent surgery, especially as a standalone for normal session for normal, pressure glaucoma.

Cherona

Thank you, and we have a gentleman who is being recommended to possibly have a trabeculectomy. unfortunately had two retinal detachments in this eye already, and he's concerned of the risk of another occurring. He has had one laser treatment that did result in his IOP being reduced about two years ago, and he wants to know if it would be beneficial to do it again.

Mr Anastasios Lavaris

So, trabeculectomy in most cases is a sight-saving operation, but it doesn't come without risks. It, usually it works well in about 80% of people, but there's always a 1% risk of losing sight.

Such as in the case of a serious infection or bleed following your surgery. So, I would recommend having your trophic colectomy,

If there is, only if there is, already advanced, if there is progression in your, of your glaucoma, and if other means do not lower the pressure or cannot stabilize your condition. Another option will be the incision of an aqueous, so of a tube in your eye. I don't feel that laser, such as SLT or an eye stand would be suitable in your case.

Cherona

If your eye pressure test at the optician is normal, how would you suspect that you had normal pressure glaucoma?

Mr Anastasios Lavaris

If your eye pressures have been consistently low, if your eye assessment has ruled out conditions such as angry closure or pigment dispersion.

If you've never used steroid medications, if you've never had surgery or an injury in your eye, then most likely it is normal, true normal pressure Glaucoma. We diagnose normal pressure glaucoma based on optic nerve examination and visual field tests.

And I explained how we usually, treat it and treat normal normal tension glaucoma and when.

Cherona

Thank you. Can PRK affect the diagnosis of glaucoma?

Mr Anastasios Lavaris

It can affect your

Pressure readings. So, if, let's say, during your PRK, your cornea has been reshaped, we might get a slight inaccurate pressure reading when we measure your eye pressure, but we do not diagnose glaucoma based on eye pressure.

We diagnose glaucoma based on visual field examination and optic nerve assessment. Those two tests are not affected by PRK, so we can still diagnose and monitor your glaucoma.

Cherona

Lovely, thank you. In response to a question that we had earlier, this gentleman has written back to say that his pressure has reduced with the use of eyedrops. What level of pressure reduction should they be looking to achieve with the surgery or with the treatment plans to prevent further damage to the nerves?

Mr Anastasios Lavaris

the research trial evidence that we have for both high pressure and low pressure glaucoma is that usually, for most patients, a 30% reduction is a reasonable target. And then we adjust the target pressure according to your follow-up visits and whether there is, there's further deterioration on your visual field and nerve tests or not.

And that applies both to high pressure and low-pressure glaucoma. Usually, medications such as latanoprost, which is very commonly prescribed, or SLT laser treatment, when it works, they offer approximately a 25% to 30% pressure reduction, which is a very good starting point.

Cherona

Thank you. Does the epiretinal membrane cause treatment problems?

Mr Anastasios Lavaris

The short answer is no. An epithelial membrane, might affect your central vision, but it does not it will not affect your treatment your Glaucoma treatment, it will not affect our glaucoma diagnosis. We can still diagnose and treat your glaucoma.

Regardless of the presence of the retinal membrane. The upper retinal membrane can be just monitored by a retinal, by a retinal specialist.

Or if it becomes bothersome, then you can discuss options such as a surgical removal of the membrane, but your glaucoma management will not be affected by that.

Cherona

We have an attendee wanting to know whether the pressure of reading in their eye is particularly high. Are you able to indicate what kind of a normal, or safe reading is, and whether a reading of 20.6 is very high.

Mr Anastasios Lavaris

That's a very good question. So, we said that we sometimes we diagnose patients with normal tension glaucoma. Normal tension glaucoma means that the pressure is within the statistically normal range, which is usually 10 to 21.

That doesn't mean that everyone who has a pressure of  22 or 23 or 25 has glaucoma.

So, if there's no damage to your optic nerve, if there's no change of your visual field tests.

So, a pressure of 20, or 22 or even 25 can be perfectly normal for some people.

While others might develop damage with pressures that are much lower and within the normal, the normal range, the statistically normal range. So, diagnosing someone just based on a pressure reading is definitely not reliable.

Cherona

That's understood, thank you. One of the attendees has experienced migraine auras, which can be very sensitive to light. Would SLT make that sensitivity worse, or increase the aura occurrence?

And, could the glaucoma have driven the start of the migraine auras, potentially?

Mr Anastasios Lavaris

Usually migraines tend to start early in life, and there is there is an association, potential association between history of migraines and what we call normal tension, Glaucoma.

So,the common denominator is what we call vascular dysregulation, so it is a disease of your blood vessels.

Your glaucoma has not caused your migraines, and your migraine is unlikely to be triggered or to get worse after SLT if you choose to have SLT laser treatment. There's no evidence for that.

Cherona

Yeah.

Thank you. Does the time of day matter when you're taking your eye drop?

So is it better, potentially, to take it in the morning or the evening, or should one be led by the instructions that are given at the time of distribution?

Mr Anastasios Lavaris

It depends on the medication. So, there are five families of Glaucoma drops. We tend to prescribe medications like latanoprost or bimatoprost at night.

But medications like Timolol, we usually prefer to prescribe them in the morning. The reason for that is that Timolol is a beta blocker medication, and it might reduce your blood pressure, not your eye pressure, during the night, which is something that might cause your glaucoma to get worse, and we wouldn't want that.

So, in general, we tend to prefer to prescribe certain drops at night and others in the morning. Some drops need to be used twice or even three times a day.

Cherona

Thank you. Does sleeping position affect the eye pressure adversely? So, depending on whether you're predominantly a left or a right side sleeper, do you find that that could affect the eye pressure?

Mr Anastasios Lavaris

Not really, just don't sleep on your eye, especially if you've had an operation recently. Just by rubbing the eye or pushing against the eye can raise the pressure inside the eye a lot.

So it doesn't really matter, unless you've had recently an operation to that eye. Just try not to push the pillow.

Against your eye.

Cherona

Lovely, thank you. And then we have, Mr Thomas, who has been told that he has a thick cornea. Is it still appropriate, to adjust the eye pressure reading because of this? Would you need to adjust that reading?

Mr Anastasios Lavaris

That's a very good question, Mr Thomas. We were using in the past algorithms to adjust the eye pressure. Our most recent or current evidence advises against doing that, but what we know is that thick cornea

is actually a positive prognostic factor, because that means that your actual pressure inside your eye is lower than what we can measure with our instruments, but we do not adjust eye pressure readings just because of that. We no longer use those algorithms.

But thick cornea is in general is a good prognostic factor, and very thin cornea is the opposite. Very thin cornea means that the actual pressure inside the eye is higher.

So it's good if you have, if you have thick cornea.

Cherona

Lovely. If you have, normal or low pressure glaucoma, are there any advantages to having the interventions that reduce the pressure?

Mr Anastasios Lavaris

The principle of treatment remains the same. Lower the eye pressure to prevent further damage.

As I said earlier, our current evidence shows that 50%, so half of people who have been diagnosed with normal tension glaucoma will not their glaucoma will not get significantly worse during their lifetime. So we might choose to monitor some of our patients with normal tension Glaucoma to first see if there's any change over time before starting before considering treating them.

But if your pre-existing damage is already advanced, and your central vision, let's say, is threatened by it, then I would suggest considering treatment for that.

Cherona

Thank you. And, this gentleman's optic nerve damage occurred without his pressure exceeding 22, so therefore it was not that high.

He'd like to know whether, pressure reduction is likely to prevent further deterioration if it wasn't seemingly responsible for the deterioration in the first place.

Mr Anastasios Lavaris

Principle remains the same. If there has been if there is already damage, or if there is documented deterioration based on your tests and your assessments over time, then, we would still I would still suggest considering pressure-lowering treatment options

To stabilize your condition, to lower the risk of your Glaucoma deteriorating further in the future.

Cherona

Lovely, thank you.

We have another question related to SLT. Having had a retinal branch inclusion a year ago, is SLT a safe procedure if this has happened in the past?

Mr Anastasios Lavaris

We would need to we would need to examine your to assess your eyes and assess your drainage, the drainage angle of your eyes.

So, in most cases, yes, unless there are new vessels in the ankle of your eye as a result of your old retinal vein occlusion. This is a condition that we call neovascular glaucoma, and we treat that differently.

But if there are no new vessels, if you have never been told that you have new vessels in the angle of your eye, then SLT is safe for you.

Cherona

Lovely. And then with regards to the alternative treatment that we offer, the eye stent, how successful is eye stent treatment?

Mr Anastasios Lavaris

IStent is safe, it lowers the pressure in most patients more than just having more than just having cataract surgery. It involves minimal disruption of the tissues of your eye.

And success, depends on the level of your glaucoma and what we define as our target pressure. So, if you've already been diagnosed with advanced glaucoma and would need to lower your pressure a lot, probably iStent would not achieve that. But if your glaucoma is mild to moderate.

Then, the majority of our patients experience, lower pressures following their treatment.

And more important than that, I stand we have very good evidence, from research on the eye stent, because there have been almost  I think three to four million eye stents being implanted globally so far, that visual field is preserved better when you've been when you've had an eye stent in your eye, which is the ultimate goal of Glaucoma treatment, is to preserve your vision.

So, the majority of our patients experience very good success and excellent safety profile with this procedure.

Cherona

Perfect. Thank you.

Right, so we hope that we've answered all of your questions. We'll just give it another 30 seconds or so, in case anyone has a question that they've not yet, been able to ask.

Okay.

Thank you again for your questions and for being part of this evening's session.

If we haven't covered your question, but you've provided your name, we'll follow up with you via email.

Mr Lavaris, can you go back to the, the page right at the end for me, please?

Mr Anastasios Lavaris

Yes, of course.

Cherona

Thank you.

So, we're pleased to offer all of our attendees, 50% of the value of your consultation.

A callback from a dedicated private patient advisor. So, following tonight's session, if you'd like to speak to somebody, you're very welcome to call the number on the screen. Our lines are open until half eight tonight, or, 8am to 6pm Monday to Friday.

You will receive an email as well with a recording of the session, treatment information, and loyalty reward points, as well as updates on future events and health news.

We'd appreciate it if you could take a moment to complete the short survey at the end of our session.

This will help us to improve and tailor future webinars to your needs. If you would like to speak to somebody to book your consultation, please do. As I mentioned, that telephone number is on the screen.

We also have upcoming webinars on a range of topics, including Arthrosamid injections, gallbladder treatment, and cataract surgery. You can sign up for these on our website.

Finally, a thank you from all of us here at Benenden Hospital for joining us tonight. And thank you to you, Mr Lavis, for your time this evening in presenting. We do hope to hear from you soon. If you have any questions or queries, please do give our team a call, and, take care and goodbye.

Vicky

Hey, once again, good evening, and a very warm welcome to our webinar on cataract surgery and special lenses. My name's Vicky, and I'm your host this evening. I'm delighted to be joined by our expert speaker, Mr Wallace Poon, Consultant Ophthalmic Surgeon.

Tonight's session will begin with a presentation from Mr Poon, followed by a live Q&A.

If you have any questions at any point, please feel free to submit them using the Q&A icon, which is at the bottom of your screen.

You're welcome to ask anonymously or include your name, but just a quick note that the session is being recorded, so any names shared may be visible in the recording.

And to help us get through as many questions as possible, if you could please keep your question brief.

If you're interested in booking a consultation, we'll share all of the relevant contact details at the end of the session.

I'm now going to hand over to Mr Poon, and I'll speak to you again shortly. Thank you, Mr Poon.

Mr Wallace Poon

Well, good evening, everyone. Thank you for joining us for the Cataract Surgery and Special Lenses talk.

I'm Wallace Poon, the Consultant Eye Surgeon. Very quick introduction, I know there's a lot of words there, but basically, I've been doing cataract for many, many years. I've done over 12,000 cataract operations, ranging around 1,500 a year. And when I was in the NHS Hospital Trust, I specialized in vitro retinal surgery.

So that means more complicated cataract surgeries and dealing with the cataract complications as well and I'm also the clinical lead of the eye department at Benenden.

So, what we're going to talk about in these sessions is various things. So, I'm going to give you a very simple overview of cataract, different types, the cause and symptoms, cataract surgery, which type of lenses you can have, how you recover, where my colleagues are, and then we go through the Q&A sessions.

So, to start with, anatomy of the eye. So, I want to show you what the eye is, and what it means by cataract. Now, if you can see my cursor, so this is the eye cut into half, okay. This is the front part of the eye, there's the back.

The cataract is the natural lens in the body. When you get older, it loses transparency. So what happened here is when the light go through, it got blocked, and this is why things are blurry.

Now, I'm going to have another view of the eye, so you can see this is when you're seeing right in front of you, that's the pupil which is the opening, and underneath the pupil is the where the natural lens is.

So imagine the eye is like a camera. So, this is the eye. The light goes through, focused by the lens, and the image projected at the back of the of the retina. And this is the camera, as I said. So the lens is where the problem is, that's what cataract is, the natural lens start losing its transparency.

So what happens when you lose the transparency? Because the lens become apexified here. You can see things become blurry. The definition has gone. Things getting blurry.

There are different types of cataracts. The first one I want to mention is called nucleus sclerosis. What that means is the lens become thicker, getting yellower.

You can see from the slit line picture of the front of the eye, which is dilated pupil, we see this yellowish hinge. This is what happened.

The catcher becomes thicker, denser, and as a result, you start losing the color, as well, not only the blurriness.

The other type is cortical lens opacity, so rather than the center become more dense, you've got these spokes appearances. Okay, that's more common in younger patients, and also more commonly associated with diabetes.

The other type is called posterior subcapsular lens opacity. Now, this type of cataract can progress very quickly, commoner in patients with diabetes, or taking oral steroids.

Now, what we meant by posterior subcapsula is, you see the lens shape? The catheter is just at the very end here, and because it's blocking the center of the, where the, where the light will be entering the eye have become very problematic and very quickly.

And this is called posterior cataract, posterior polar cataract, that means there's only the opacity right in the middle there, but not spreading much, and it's more common as a congenital type of cataract which you were born with.

So, what caused cataracts, then? The most commonest reason is age. When you get older, The lens become denser.

If you smoke, it's more likely you will have the cataract sooner rather than later. If you are having systemic disease, like diabetes, like I mentioned earlier, or you can be born like that, and you're more likely to develop cataract at a younger age, or it's traumatic.

That means if you had blunt injury to the eye, cataract can form quite quickly and also, it could be dropped later, like what I said earlier, if the patient's using topical steroid drops or an oral steroid, and that accelerate the formation of cataract.

So, what will you notice if you've got a cataract? How do you know? So, the first thing is the color becomes more faded.

Now, what does that mean is, with nuclear sclerosis, the first type of cataract, you know, the yellowish cataract I showed you earlier, you start losing the blue spectrum of the color vision. So, you might still be able to see, but things are not as bright and vivid and the other thing is blurred vision.

Also, when you're driving at night, you might notice there's a lot of glare, especially with oncoming traffic light. And this is why, when people get a bit older, they don't like to drive at night, because, number one, your people get dilated in a dark environment, and that put the cataract more in play. And because of that, there's a lot of glare.

And it's making looking at oncoming traffic lights, or even seeing at night, is very difficult. And also, you might notice, oh, my glasses is not right now. You go to your optician, they change your prescription, and you said, it's not right again after a few months. That is because especially if you call the type called nuclear sclerosis, because the cataract got denser, the reflective index changes.

And that means it will make you more short-sighted. So that's why you need very frequent changes of glasses. And the other thing is double vision.

Now, double vision can be caused by both eyes, or just what we call the monocular diplopia, just like you have double vision in one eye. Just because of the catch that was formed.

The images were not projected correctly at the back of the eye and causing the provision.

So, okay, I've got those symptoms. Do I need operation, then? Yes, you do. If affecting your daily life or your activities. For example, you need to drive at night. Now, with the cataract, you can't really see the drive at night, so there's a very good reason why you should.

And also, there's a government's requirement for driving. You should be able to see certain distance before you're qualified, or you're legally allowed to drive. So, in order to drive, you might need to have the cataract done, because the glasses, or changing the glasses, can only help you to a certain extent.

And also, sometimes, with the cataract, it will affect your hobbies, especially if you're painting or reading.

Cataract means you will lose perception of color, or having very difficult to near close work, and caring for grandchildren as well. So there are other reasons why we would suggest doing cataract operation.

Not necessarily to do with the vision, but to do with certain clinical condition, like angle closure glaucoma, or sometimes we need to go to the back of the eye for retinal detachment. We will do the cataract operation at the same time.

Or because they have got certain eye disease, we need to have a very clear image to examine the eye properly, and the cataract affecting what the doctor does. So those are the clinical reasons that would be worthwhile to have the cataract surgery.

Now, very interesting facts. In Claude Monet, I think we know who he is, he's a French impressionist. He was diagnosed cataract in 1912.

But he doesn't want anything done, because in those days, there's a big, major ticking. In the sense that they can't guarantee the prognosis, you can't put the lens implant in.

And so he delayed the operation for many years. You can see, in 1899, when he draw the lily, the water lily, it's very clear, you got a lot of definition, but later in life, in 1922, before he had a cataract operation, the color is completely different.

Everything is more yellowish, and murky, and red, and dull. And blue becomes darker, and it's indistinct. So you can see how that can affect your perception.

Now, we'll never wait so long now, until you have the cataract done, because of the modern technology, and because of the, because the surgical techniques now have evolved so much.

So you need the operation when you need the operation.

So, what do we do, then, when you come for the cataract surgery? So, preoperatively, you'll come to see the eye nurse and the technicians, because in order to get the right implant for you, we need to do a lot of measurements.

And also, we need to understand you better about your medical social history. Making sure your blood pressure is alright, your blood glucose is alright. We would then check your visual acuity.

I think all of you will have it done when you go to see an optician, you read a board, and that gives you or give us an indication how good or your bad or your eyesight is.

We also will measure the pressure inside the eye, because unless you measure, you never know there's a other ophthalmic conditions, like glaucoma, until we measure, we don't know, and then we do the biometry.

Biometry means we need to take measurement of the eye, the curvature of the front part of the eye, and also the length of the eyeball, and the computer will be very clever carve out a list of lens options to decide how long or short-sighted you will be post-operatively. And also, we will, in certain cases, we do a pentacam.

That is a special investigation tool to look at the curvature of the front part of the eye. Now, which I'll mention later, for example, patients with special lenses implant, we need to be very precise to know the curvature, so we can select the lens bespoke for you.

And also, we'll do the OCT scan of the macula. What that means is we want to look at the health status at the back of the eye.

Because, again, your eyesight could be poor because of cataract, or something else. And this is that something else we need to make sure we're not going to miss.

So, after you've done all the measurement, the consultant will see you. So we examined the eye, we'll discuss and confirm your eye history, medical history, we'll look at all the investigations, and then we'll discuss what type of anaesthetics you will have.

Now, majority of the patients have topical anaesthetics, that means eye drops only, and you'll be awake during the procedure. Very rarely, we will give an injection into the eye to stop the movement of the eyeball. That's called subtidal anaesthetics.

Very, very unlikely we will need to perform general anaesthetics, which, unfortunately, general anaesthetics, we will need to refer you to the NHS hospital, because we don't have the facility at Benenden to put you to sleep to do the operation.

Again, we'll discuss the surgery itself, the risk of the operation, and then we'll choose with you the type of lenses most suitable for you, and the refractive outcome. Now, what do I mean by the refractive outcome is, for example, I'm short-sighted, so that means if I take my glasses off.

Well, basically, I can't see a lot. And if I need to drive, I will need my glasses all the time for driving. However, when I perform the cataract surgery, I can have the facility choose a lens which make you normal-sighted again.

What that means is, rather than having glasses for distance, I can have the lens in, then I'll be able to see distance, or watching television without glasses, but then I need glasses for reading.

So there are lots of choices, and not to mention about the special lenses as well, which will be able to do a lot more and then we'll ask you for the consent for surgery, and then we book you a day for the operation.

Now, let's get back to the lens options, okay. So, the commonest lenses we use is called monofocal lenses.

What that means is there's only one focusing distance, okay. Give you the clarity of vision. Like what I mentioned earlier, I want to have perfect distance vision. So I'm perfect for distance, but I need glasses for reading. And some of my patients are like, no, no, no, no, I'm used to short-sighted.

I much prefer I will be able to read with my book without glasses, and I'm happy to wear glasses for distance, like what I used to be. So then we will choose a lens suitable for that purpose.

So, what I also need to mention is astigmatism. You might have heard that term before, you might not, but what that means is the surface of the eyeball, the cornea, ideally should be like a football, nice and round. However.

There are certain patients, the eyeball is more like a rugby ball, so the surface is more curved in one dimension to the others. For those patients, the monofocal lenses will not work, and you will need glasses for both distance and near if you want to have perfect sight.

Their astigmatism, however, can be neutralized with the special lenses.

So what do we mean by special lenses? Okay, this is extended depth of focal or multifocal lens implant. Now, you can see from the diagram here, there's a lot of brown fragments. What that means is imagine you're wearing varifocal glasses. Very focal glasses allow you to see distance and near. Special lenses will do the same thing, but it's put inside the eye.

So that means, with the special lenses implant.

You should be able to see distance clearly, and near.

Clearly. Now, obviously, it depends what you aspire to do if you do sewing, and even the special lenses might not be strong enough, and you might need top-up. But majority of patients, with the special lenses implant, they will become more spectacle independent. That means

Most of the time, you will be able to do without any glasses.

Okay.

the astigmatism can also be corrected with the toric element. So basically, the lenses

implant will be tilted more in one dimension to neutralize your astigmatism in your cornea. So these are very clever lenses, and this has been, you know, been very popular for the last 10 years, technology moving on and making it more predictable, much better outcome.

So this is a toric lens we're talking about, aka, the eye is normally round like a

like,

Football, but with astigmatism, it's more like rugby ball, and that astigmatism can make things blurry, but then either that astigmatism can be corrected with glasses, contact lenses, or we can put a special lens with a toric element in it to neutralize it.

So. we talked about the lenses, so we chose the lenses now, so you want to have the monofocal lenses, so you come for the surgery. So what happened on the day of the operation? So, you'll be given a time, you arrive, you'll be greeted by the nurses.

So what is important is we need to dilate the pupil, because in order to get to the cataract, we need your pupil to be well dilated. We also will check your blood glucose, your blood pressure, so sometimes you get very excited, come to see me, and your blood pressure should sky high. Not a good thing, because

if you've got a very high blood pressure, you might increase the risk of complications of bleeding in the eye. So, we need to make sure you're in the perfect condition for the surgery. So, if you're very nervous, we can give you oral sedation. We won't put you to sleep, but we make you more calm. Now, I suggest

Wear dark-coloured clothing, only because when we do the surgery, we need to clean your face with iodine, and accidentally, you know, there might be droplets of iodine, go to your nice clothing, and probably you don't wear any white.

Also, have light meal, breakfast. Now, you might be surprised, I need to remind you, no alcohol. Some patients are so nervous, they actually have quite a bit to drink before they turn up to the surgery.

So, during the operation, you will be asked to sit in an operating chair, it's a bit like the dental chair. We will make sure you're comfortable, making sure the head position is correct, and we'll put more local anaesthetics in.

In forms of eye drops, and some iodine drops as well, which start the cleaning process. And then we'll clean your eye and put a plastic drape. Now, what we mean by a drape is it's a transparent plastic sheet to cover the surgical area to keep it clean.

Sometimes the patient is feeling a bit claustrophobic, but can be lifted up from the face, and then we're going to put a small speculum to keep the eye open. That is, keep the eye open for the surgery. The other eye will be covered, so you're not going to see anything I'm doing. And then there will be a bright

Light, which I will ask you to stay at this, is the operating microscope, and there's a bright light coming, and the surgeon will be seeing through the microscope to see what we're doing, and you'll be asked to look at the three tiny dots in the middle, and you want to do that for the rest of the surgical time.

And we will be probably playing some music as well, or the music of your choice, making sure they're calm. Definitely no singing, no dancing during the operation, any movement could be bad. So, we will remind you, keep calm, keep breathing, and keep still.

So what do we do then when we do cataract operation? So, we'll make a very small step, incision in cornea, and we make a tiny hole in the capsule, which is holding the eye, cataract, and then we'll use an ultrasonic needle, break the cataract.

We clear out all the, residual, cataract fragments, or we call soft lens better. We put a lens implant in, we put antibiotics inside the eye, we'll seal the wound, and we'll give you or put a transparent shield over. Now, the transparent shield is reminding you do not rub your eye after the operation.

So, these are some, diagrams. So, this is the eye in a three-dimensional view. So, there's a blade, we get inside the eye. We use an ultrasonic needle. You'll hear some funny noises, that use an ultrasonic energy to break the cataract and suck it up at the same time. And after we clear all out, that's the lens implant putting inside the capsule.

And you can see here, the lens implant is in place, we don't need any stitches. In majority of the time, I would say 99%, and the wound is self-healing.

And we expect you to see better, probably in a day or two. Within one month, you will be completely healed. So that means after the procedure, making sure, for the next month, no contact spots. I tell my patients, no boxing, no swimming, and just be careful.

Generally speaking, because the last thing you want is a perfect operation, and you rub your eye, or you have trauma, and then ruin the good work.

So, recovery. Now, we expect you to have a bit of discomfort. Now, at the end of the day, you do have an operation, okay? But simple painkillers, paracetamol, will normally do the trick.

You'll be given some eye drops to use to prevent infection and to control the swelling and the inflammation. That's in the form of combined steroid and also antibiotics.

Now, as I said, vision will be blurry straight afterwards, but that will recover very quickly.

Several hours after the local anaesthetics wears off, you can start to feel your eye properly again. Now, because during the operation, we put a lot of local anaesthetics, and there's a bright light shining in the eye, so it takes time for the function to return. And as I said, we'll cover it up with a plastic shield.

So, healing four to five, four to six weeks, you should be healed completely, okay. Now, the nurse after the operation will have a debrief of you, explain to you what you need to do in very clear details, and answer your questions.

If you got anything you're not happy with after the surgery you went home, there's an emergency phone call, phone number for you to call, so you'll be always have someone to look after you and support you.

So, cataract operation is very successful. It's a very safe operation, 99% patients see better. But with any surgical intervention, there are risks and complications.

Okay, so It could be intraoperative, so when we do the operation if you keep moving, that will make the operation very difficult, and sometimes we can cause a tear in the capsule. Now, what we meant by that is that a capsule is the structure that's holding

the cataract, or your natural lens, and it's a very, very small space we are operating on. So if you move, and we might cause a tear in the capsule, if that happened.

The cataract might sank to the bottom of the eye, and you might need more surgery to fix it.

After the surgery, there are also risks, because you have a wound in your eye, if you rub it accidentally, dirty water gets into the eye.

Very rarely, you can have a severe infection. Chance of that happening is one in 1,200.

If you do have an infection. we can still treat it, but the outcome might not be as favourable. And very, very rarely, 1 in 10,000 patients can go blind, lose the eye because of the infection.

Some patients might take a bit longer for the inflammation to settle, and but generally speaking, in four weeks, we expect you to see a lot better.

After the cataract surgery, around 10% of patients, the capsule which is holding the lens implant can become thickened with time and that might need some laser correction.

What we meant by that is, it's an outpatient procedure, the laser will open the gap on the capsule, and it doesn't come back again, so it's a one-off procedure.

As I said, it doesn't happen to everyone, but 5-10% of patients, you might need to. You will notice the eyes, they become more blurry, a bit like when you had the cataract.

But the procedure, the treatment, is more straightforward, and is not an operation, but an outpatient laser procedure.

All these will be discussed in details with you when you come to see us in the consultation.

So about our eye unit, okay. It's a unique, dedicated eye unit. We've got our own space, okay? It's a very nice environment. It is housed in the fairly newly constructed part of the Benenden Hospital. We've got the latest investigative tool, the latest surgical instruments, and we've got 7 very experienced consultants.

We are all NHS consultants working in the East Kent or West Kent areas.

We've got a dedicated ophthalmic Nurses administrative team that will help you all the way, and the cataract Pathway is specially designed for that purpose.

What I meant is, I want you to be seen, you have all the information you need, and then you can quickly go home. Same as a surgical intervention. You don't want to hang around the whole day. You will be you'll be given a very specific time.

For the surgery is either in the afternoon list or morning list, you'll come home, you will be able to spend a few hours with us, and you're ready to go.

We are rated by the CQCS outstanding, which is only 8% of the NHS trusts have achieved this highest level rating.

And we're going to continue to, you know, learn more from our patients, what we need to improve. So, if you do come to see us, have the surgery, if you've got any feedback, please let us know so we can get better.

So these are our farming consultants, that's quite a lot of us, and I just want to point out, Mr. Aboshiha and Ms Han Bin, they are our special lens specialist, what we call the anterior segment surgeon. So, only they are specially trained to answer your query on special lenses, and they will be the one doing the operation.

The special lenses also, once we decided what you need, we find a suitable one for you, and they need to be bespoke to order, either in Germany or France to ship over to England, specially for you. So, this is why, you will notice it reflects on the pricing.

So if you're a self-paid patient, the monofocal lens, just the surgery for one eye is around £2,800. Special lenses, all these are special lenses doing various things, it will go up to £4,000-something. Depends on the functionality of the lenses.

However, for Benenden members, having the special lenses is very, very, cost-effective, because you do not need to pay for the surgery, but you pay for the lenses, okay. So rather than paying monofocal lenses to rate £4,300, you pay an uplift of the lenses.

Okay, and if you want to know more about, special lenses or normal monofocal lenses, you're more than welcome to, ask us.

I also want to let you know there's an exclusive offer, if you're listen to my lecture, you want to come for a consultation, if you're self-patient, use the code, you've got 50% off, and I'll leave it to Vicky now, and if you've got any questions, very happy to answer your queries.

Vicky

Lovely, thanks, Mr Poon. So yeah, we'll move on to our, Q&A session now.

So, we're delighted to have so many of you join us today. We might not be able to answer every question, but we'll do our best to cover as many as we can.

So, our first question, this person says, I'm at risk of glaucoma. My diagnosis is suspected COAG with normal IOP.

Can I still have my cataracts fixed and have special lenses?

Mr Wallace Poon

To start with, yes, definitively, cataract operation is sometimes part of the treatment, because once the cataract is removed, believe it or not, your eye pressure actually drops by around 2 to 3 mmHg.

Whether you can have special lenses depends on the investigative findings.

One of the exclusion criteria

is glaucoma. If you definitively got glaucoma, we do not want to put special lenses, because you need to have perfect ophthalmic function for the special lenses to work. So whether you're suitable or not, it would be depends on what we find.

And also want to let you know, in the very near future, we'll talk about in a few months, Benenden will launch a glaucoma service as well, and that will include making a diagnosis.

Also, we'll be able to provide laser treatment or you can have cataract operation with a micro-stand to be inserted. Now, what that means is it's a drainage procedure, so not just you get the cataract done, and that will allow to have much better control of your intraocular pressure, to the extent that majority of patients will not need to use eye drops for glaucoma.

Anymore. So, watch this space, there will be another webinar regarding the glaucoma surface, which I hope you will be able to attend.

Vicky

Lovely, thank you, Mr Poon, hope that was helpful. Our next question, I have high myopia, minus 7.25, and I'm keen to find out which surgeon is highly specialised in high myopia cataract surgery.

Mr Wallace Poon

Right, now, minus 7.5 is actually not that bad. When we say really high myopia, pathological ones, we're talking about minus 20.

So, I have to say, all the consultants, which you saw the pictures, any of them will be capable to do the operation. I think in your case, it's more likely, what do you want to have post-operatively? Because you're minus 7, which I think you're quite used to, thick glasses.

And you might need to read very close when you're holding a book. We can make you around minus 3, let's say, so you can read your book without glasses.

Along the normal distance, or looking at your computer screen, but with glasses for perfect vision. So, to answer your question, any of us will be able to do the surgery for you if you're minus 7.

Vicky

Lovely, thank you, Mr Poon.

Next question, on a very similar, theme. What are the success rates for surgery for a minus 15 prescription and reading prescription?

Mr Wallace Poon

No.

Okay, so we will talk about the surgical success, and also the surgical risk. If you're minus 15, when you're minus 15, that means your eyeball are longer. This is why you short-sighted, because the focus is in front of the retina.

If your eyeball is longer, structurally, you might be more prone to have complications.

Like, you know, your soreules might be more loose. Also, you're more likely to develop a retinal tear or detachment.

And also, with your eyeball, it's very long, the prediction from the measurement might not be as correct. I think this is unfortunately, the constraint we will have. So surgically, it could be as successful as any other people having cataract operation, but the refractive outcome, we might not be able to spot on and as precise.

But if you've got a bad cataract, you're minus 15, you will still notice a lot of improvement following the operation but I think the nuancing is that is on the consenting process, you know? We need to let you understand what the constraints are, what the likely outcomes are, and we need to do that face-to-face.

Vicky

Okay, lovely, thank you. Hope that was, reassuring for you.

Our next question comes from Gaynor, and Gaynor asks, can a cataract cause balance problems?

Mr Wallace Poon

Yes.

Definitely, because I think one of the symptoms you can have cataract is causing what we call monocular diplopia. That means using one eye, you actually see double. And you can see, if you've got two eyes, got cataract, you've got four images. Yeah, definitely, you will lose your balance.

Or also because your vision become blurry you are not certain what you're seeing, and that also affects your balance as well. So, yes, that's another reason that you might need to consider having the cataract surgery.

Vicky

Lovely, hope that was helpful, Gaynor. Next question. I have very dry eyes. Will cataract surgery make it even worse? What can I do to alleviate this, if so?

Mr Wallace Poon

The dry eyes is separate from the cataract. The dry eye is to do with the ocular surface. You can have multiple reasons why you have dry eyes, or the most common thing is people have a certain degree of blepharitis, or they could have rheumatoid arthritis not producing enough tear. That is a completely different thing to cataract.

Having dry eyes do not stop you having cataract operations. However, when we do the cataract surgery, as I mentioned, we need to put a speculum, keep the eye open.

Sometimes, with the speculum putting into the eye to do the surgery, it can exacerbate blepharitis, and as a result, you might notice more symptoms because of the dry due to the dry eyes after the surgery. But majority of patients will just get back to normal. And then also, if you've got the dry eyes, there are various means we can help you.

Different type of, different type of eye drops, finding you the right one, and also advise you on eye hygiene, and there's also some treatment available, that we can offer.

Vicky

Okay, thanks very much.

The next question is around, having floaters. This attendee says, I have floaters. Will these be resolved by cataract surgery?

Mr Wallace Poon

No, it won't. Now, if it might be easier if I answer the question with the anatomy of the eye, so I'll very quickly go back to slide number one. Okay, so this is a cross-section of the eye. As I explained to you earlier, this is the lens.

Okay that's what's causing problem with cataract is in front.

Floaters is at the back, so we are talking about a structure called vitreous humor.

You can imagine the vitreous humor occupies quite a large portion of the eye, it's more like a jelly structure.

Unfortunately, when one gets older, the jelly structure become liquefied. And eventually, they kind of condense and they form these things floating around, which is very annoying. I'm short-sighted, I've got quite a lot of them floating around.

Doing the cataract operation here will not affect what happened at the back.

So, to answer your question is no, cataract operation will not affect the presence of floaters. However, if you've got a very dense cataract, after that is removed, you might actually see more filters, because now the light is passing through easily.

Vicky

Okay, lovely, thank you. Hope that was reassuring.

Next question is about, sedation. So, do we automatically get offered sedation, or do we have to specially request it? I think it would make me more relaxed.

Mr Wallace Poon

Everyone able to have sedation. We normally give you a very small dose of, diazepine. It's like 2.5mg or 5mg. We definitely don't want you to fall asleep. The worst thing that happens is you fall asleep during the operation, and you suddenly wake up during the operation.

But a very small dose will be able to relax you and every patient's coming in to see us, will be offered if they wanted to use it.

Vicky

Okay. That's great, thank you. Hopefully that was so reassuring. Next question is from Philip, and Philip asks, would you normally do both eyes at the same time? If not, what is the interval between operations?

Mr Wallace Poon

It depends. If it's a monofocal lens, We normally do one night at a time. For special lenses, we normally will do both eyes at the same time.

Reason for that is the period of recovery, because with the special lenses, just like you're wearing varifocal lenses, it will be very difficult if you have one has got all these functions, and the other one hasn't.

So, for those cases, we will normally do bilateral cataract surgery. Now, the only concern is, as I mentioned earlier, any surgical intervention, the risk of having a nasty infection.

That is very small. A lot of the NHS hospitals now actually do bilateral cataract surgery, even monofocal lenses at the same time. At Benenden, we only do one at a time, and also depends on whether you refer from the opposition for one eye, or both eyes, and what your either the society approved, or what we what we found, because not infrequently, some patients got only one cataract, and the other one, they're coping.

And they don't even want, both eyes to be operated on, not sequentially, or not simultaneously. So, at Benenden, monofocal lenses, we most likely, we do one eye at a time. Special lenses, we'll do both eyes at the same time.

Vicky

Okay, lovely, thank you.

Next question.

Mr Wallace Poon

I forgot to tell you. So, after the first operation is done, we automatically will book you for the next operation, because we want to make sure that eye will recover. So, probably we will do the second eye around 4-5 weeks.

My apology.

Vicky

Right, thanks, Mr Poon. I hope that was helpful, Philip.

Next question is from James. James has got a couple of questions, actually. I think we've already covered this one, but I'll ask it anyway. Can a cataract operation be performed if I have open angle glaucoma in my left eye?

Mr Wallace Poon

Definitely. But I think with open angle glaucoma, we will not advocate you have the special lenses because of potential or you already suffer from nerve damage.

However we will be able to do the cataract operation in the very near future, and also do the drainage surgery at the same time.

Vicky

Lovely. And James goes on to say, I also have a small lamella hole in the retina of my right eye. Is this a problem?

Mr Wallace Poon

Right I think you can still see my cross-section of the eye. What we mean by lamella always.

This is a cataract. That's the retina. Retina is like the film of the camera. Lamella hole means the macular area, which is the centre part of the retina responsible for all the detailed vision, like the film of the camera. You've got the split or is not completely, functional.

It will not affect the operation, but it might affect the final outcome of the surgery.

But a lot of patients with lamella hole, or lamella changes, on the macula, they will not affect their eyesight at all. So, to answer your question, we need to look at it when you come, and we need to see how bad your lamella hole is. But to

To be specific, the lamella hole will not affect the cataract operation itself.

Vicky

Okay, lovely. Hope that's helpful, James.

Next question is from Nick, and Nick is a member of Benenden Health, and he wants to know whether or not he needs to be diagnosed as needing a cataract operation on the NHS before qualifying for treatment.

He says he has cataracts in both eyes, but his optician says he's not yet reached the NHS threshold.

Mr Wallace Poon

Right, now, that's an administrative issue. From what my understanding is, I think you can probably ask your optician to refer you to Benenden.

That depends on where you live, because there are certain, what we call the local ICB, this is a government organization,

They don't want to refer patients because they increase their waiting time, and of course, they need to pay for the procedure.

The clinical criteria for having operation is how much is affecting you.

If it's affecting your daily life, then you should be having the operation done.

I think it really depends and how much inconvenience, you're suffering from.

If you say you're driving at night, now you cannot drive, I think that's good enough indication for you to be referred.

Vicky

Okay, thank you, Mr Poon. So I guess the answer is to speak to your optician again, on that.

A couple of questions here, on driving, so a couple of people have asked, how soon after the treatment can they start driving again?

Mr Wallace Poon

Well, for example, you're having monofocal lenses, you have one eye done, followed by the other, so probably you don't want to drive until both eyes at the operation, because otherwise you'll be a bit offside. And also, after the cataract surgery, if you do have astigmatism you might need glasses to get your best vision.

But at the end of the day, it's how quickly you're happy to do so. We normally will advise the patient to see their optician, four weeks after the cataract surgery and some patients might not need glasses, and as long as you feel comfortable enough, because, as I mentioned earlier, after the cataract operation, you will feel some discomfort, so you don't want to go straight for driving, until you are comfortable enough, or confident enough to do so.

That apply to especially special lens patients, because they will have both their eyes operated on, and they might see better in 2 weeks already, and they might fulfil the criteria of driving, or they're happy enough for driving, they can they can go ahead.

Vicky

Okay, lovely. And following on from that, Morag also asks how, soon she'll be able to work in front of a computer screen?

Mr Wallace Poon

And again, depends how comfortable you are. I think, you know, after the cataract operation, even just unilaterally, you have one eye done, you will have the, eye shield, you wear for 24 hours, and you wear it at night. So, even the next day or in a few days' time, if your eye is not uncomfortable, you can do whatever you want, except

Physical exercise, except rubbing your eyes, because, you know, definitely swimming is no good. But in front of a screen, if you're happy enough watching telly, that should not stop you.

Vicky

Lovely, thank you for that one. That's helpful, Morag.

Next question is from Julia. Julia had cataract surgery about six years ago. She's now been told that she needs laser surgery to correct blurring in one eye, as she also has dry eyes. Will this be worse after laser treatment?

Mr Wallace Poon

Right, now, I'm going to go back to the diagram, okay? So, as I mentioned earlier, this is the lens, this is your natural lens and the lens is kept in place with a capsule.

Okay what we mean by capsule thickening is that capsule, after the lens implant is put in, 5-10% patient, as I mentioned earlier, that capsule can become thickened.

So, what the laser does, the laser open the hole at the back. It doesn't touch the front part of the eye and when you have got dry ice, it's to do with the ocular surface.

So it's unlikely it will make your dry eye worse, and it's unlikely your dry eye will affect what we do with the laser.

Vicky

Okay, lovely. Hope that was helpful, Julia.

I've got time for another couple of questions. So somebody's asked, do PVDs in both eyes affect the outcome of cataract surgery? I'm about minus 7 prescription.

Mr Wallace Poon

Okay, PVD means posterior vitreous detachment. That's what I meant earlier. The jelly structure, when you get older, especially if you're short-sighted, they kind of liquefied, and eventually the whole jelly structure come away from the back of the eye.

So, that's what we mean by posterior vitreous detachment, and with that, you see a lot of you probably see a big floater. And with time, the floater goes away, because with gravity, the floater sends the bottom part of the eye.

When we do the cataract operation, we do not go to the back.

So, when we do the cataract operation, we are well separated from the vitreous, so the cataract operation will not be affected by whether you have got vitreous detachment or not, and I know you're short-sighted, and that depends on the choice of the lenses, what your visual outcome will be.

As I said, if you've got a very bad cataract, getting rid of the cataract may make your vitreous floaters more noticeable or not, depends on where your vitreous is but from the surgical point of view, no problem.

Vicky

That's great, thank you. I hope that's, answered your question.

Next question, is it better to have cataract surgery before the cataracts get really bad?

Mr Wallace Poon

That go back to our same, question or answer earlier, you have the cataract when you need it.

It's not like the old days, because, you know, when Monet have his cataract done, he wait for 11 years, because that was a big procedure, and the prognosis is unknown. Nowadays, with cataract operation, the success rate of seeing better is 99%.

So, you do not wait until it's ripe, but you have it done when it's interfering with your daily life.

Vicky

Okay, lovely, thank you.

Next question is from Elizabeth, and she says, I have ERM in one eye, but I want the other eye to be able to do distance as well as reading.

Got any comments on that?

Mr Wallace Poon

Right. ERM means epiretinal membrane. Now, okay, I'm very glad I've got the cross-section of the eye. What that means is you have got the vitreous detachment, like the previous gentleman asked. The vitreous detachment triggered off a very mild inflammatory reaction, causing a scarring on the macula.

Okay, that's called epiretinal membrane. Majority of patients with epiretinal membrane doesn't really affect their site.

Okay, however, there's certain patients that epiretinal membrane will get worse and as a result, your eyesight can get can deteriorate.

And there's a procedure that we can go to the back of the eye to peel it off. Now, this is nothing to do with the cataract.

However, with the epiretinal membrane, most likely, you will not be suitable for the special lenses but surgically, it is not going to affect what we do.

You can still have your eye perfect for distance, or perfect for near, that doesn't matter, you are absolutely fine for monofocal lenses but not special lenses.

Vicky

Okay, thank you, Mr Poon. I hope that was helpful, Elizabeth.

And our final question this evening, in terms of physical exercise after treatment, is running okay?

Mr Wallace Poon

That depends on how quickly you want to do the running.

I think, as we mentioned earlier, your eye might be a bit blurry, a bit uncomfortable. I think that you just need common sense, really. I think if you're absolutely fine after a week, yes, go running, as long as you don't get that eye hit, or you don't you don't want to accidentally got sweat in your eye, you start rubbing it, that would be

Very bad thing to do, and increase the risk of infection. So there's no definitive time whether you can go running or not.

But their definitive sign not to go swimming, nor contact spots. So I think Whatever you feel comfortable with.

Vicky

Okay, lovely, thank you.

I wonder if you could move to the last slide again, Mr Poon, just so we can, thank you.

So thanks everyone for your questions, and being part of this evening's, session.

So, just going to move to the last slide that's got, some information on there. So, as Mr Poon mentioned earlier, as a thank you, for attending, we're pleased to offer, 50% off your initial consultation.

Call back from your dedicated Private Patient Advisor, an email with a recording of this session, treatment information, and also loyalty reward points, and updates on future events, at the hospital, and health news as well.

We'd really appreciate it if you could take a few minutes to complete the survey at the end of this session, as it really helps us to improve and tailor future webinars to your needs.

If you'd like to speak to somebody to book your consultation or for information, our private patient team is available until 8pm this evening.

And then from 8am to 6pm, Monday to Friday, and you'll find the contact number on your screen just there.

We've got, plenty of webinars coming up on a range of topics, including treatment for enlarged prostate, treatment for hip and knee pain, varicose vein removal, heartburn and acid reflux, and plastic surgery, and you can sign up for these on our website.

So finally, on behalf of Mr Poon and all of us here at Benenden Hospital, thank you ever so much for joining us this evening. We hope to hear from you very soon. Take care and goodbye.

Mr Wallace Poon

Thank you, everyone. Look forward to seeing you at Benenden.